Rate of recurrent hydronephrosis after laparoscopic ureteroneocystostomy for ureteral endometriosis

Study objective To investigate the short-term outcomes of laparoscopic ureteroneocystostomy in patients with ureteral endometriosis (UE). Design Retrospective cohort study of consecutive patients who underwent surgery for the ureter endometriosis with hydronephrosis. Setting A private hospital that provide primary, secondary and tertiary care. Patients 30 consecutive patients with UE who underwent laparoscopic ureteroneocystostomy at our institution between May 2008 and April 2020. Interventions Laparoscopic ureteroneocystostomy, if necessary, hysterectomy, salpingo-oophorectomy, cystectomy, partial bladder resection, or partial bowel resection were performed. Measurements and main results The most common chief complaint was pelvic pain (40%). Endometriosis affected only the left ureter in 56.7% of patients, only the right ureter in 33.3%, and both ureters in 6.7%. Involvement of the ipsilateral ovary was confirmed in 64.3%. The most frequent location of UE was 1–3 cm above the UVJ (46.7%). A psoas hitch was performed in 7 patients (23.3%), and the Boari flap was used in 9 patients (30%). Hysterectomy was performed in 12 patients (40%), and 6 of them had a concomitant bilateral salpingo-oophorectomy (20%). In addition, 3 patients (10%) underwent partial bowel resection, and 2 patients (6.7%) underwent partial bladder resection. After surgery, 24 of 27 patients (80.0%) were free of sever hydronephrosis after surgery. Hydronephrosis recurred in a single patient (3.3%), but the grade of hydronephrosis improved significantly after surgery (P < 0.001). At 6 months of follow up, 4 patients (13.3%) experienced urinary tract infections and 2 patients (6.7%) reported dysuria. Patients reported a regression of dysmenorrhea symptoms (P < 0.001).

This study shows that ureteroneocystostomy provides good results in terms of relapses and symptom control in patients with ureteral endometriosis. Similar content being viewed by others

Vercellini P, Viganò P, Somigliana E, Fedele L (2014) Endometriosis: pathogenesis and treatment. Nat Rev Endocrinol 10(5):261–275 Abrao MS, Dias JA, Bellelis P, Podgaec S, Bautzer CR, Gromatsky C (2009) Endometriosis of the ureter and bladder are not associated diseases. Fertil Steril [Internet] 91(5):1662–1667. https://doi.org/10.1016/j.fertnstert.2008.02.143 Berlanda N, Vercellini P, Carmignani L, Aimi G, Amicarelli F, Fedele L (2009) Ureteral and vesical endometriosis. Two different clinical entities sharing the same pathogenesis. Int J Gynecol Obstet 64(9):615–623 Vercellini P, Pisacreta A, Pesole A, Vicentini S, Stellato G, Crosignani PG (2000) Is ureteral endometriosis an asymmetric disease? BJOG An Int J Obstet Gynaecol 107(4):559–561 Antonelli A, Simeone C, Frego E, Minini G, Bianchi U, Cunico SC (2004) Surgical treatment of ureteral obstruction from endometriosis: our experience with thirteen cases. Int Urogynecol J 15(6):407–412 Uccella S, Cromi A, Casarin J, Bogani G, Pinelli C, Serati M et al (2014) Laparoscopy for ureteral endometriosis: Surgical details, long-term follow-up, and fertility outcomes. Fertil Steril [Internet]. https://doi.org/10.1016/j.fertnstert.2014.03.055 Bosev D, Nicoll LM, Bhagan L, Lemyre M, Payne CK, Gill H et al (2009) Laparoscopic management of ureteral endometriosis: the Stanford University Hospital Experience With 96 Consecutive Cases. J Urol [Internet] 182(6):2748–2752. https://doi.org/10.1016/j.juro.2009.08.019 Barra F, Scala C, Ferrero S (2018) Current understanding on pharmacokinetics, clinical efficacy and safety of progestins for treating pain associated to endometriosis. Expert Opin Drug Metab Toxicol [Internet] 14(4):399–415. https://doi.org/10.1080/17425255.2018.1461840 Nezhat C, Paka C, Gomaa M, Schipper E (2012) Silent loss of kidney secondary to ureteral endometriosis. J Soc Laparoendosc Surg 16(3):451–455 Gennaro KH, Gordetsky J, Rais-Bahrami S, Selph JP (2017) Ureteral endometriosis: preoperative risk factors predicting extensive urologic surgical intervention. Urology [Internet] 100:228–233. https://doi.org/10.1016/j.urology.2016.08.016 Barra F, Scala C, Biscaldi E, Vellone VG, Ceccaroni M, Terrone C et al (2018) Ureteral endometriosis: a systematic review of epidemiology, pathogenesis, diagnosis, treatment, risk of malignant transformation and fertility. Hum Reprod Update 24(6):710–730 Lusuardi L, Hager M, Sieberer M, Schätz T, Kloss B, Hruby S et al (2012) Laparoscopic treatment of intrinsic endometriosis of the urinary tract and proposal of a treatment scheme for ureteral endometriosis. Urology [Internet] 80(5):1033–1038. https://doi.org/10.1016/j.urology.2012.07.036 Stein R, Rubenwolf P, Ziesel C, Kamal MM, Thüroff JW (2013) Psoas hitch and Boari flap ureteroneocystostomy. BJU Int 112(1):137–155 Knabben L, Imboden S, Fellmann B, Nirgianakis K, Kuhn A, Mueller MD (2015) Urinary tract endometriosis in patients with deep infiltrating endometriosis: prevalence, symptoms, management, and proposal for a new clinical classification. Fertil Steril 103(1):147–152 Maccagnano C, Pellucchi F, Rocchini L, Ghezzi M, Scattoni V, Montorsi F et al (2013) Ureteral endometriosis: proposal for a diagnostic and therapeutic algorithm with a review of the literature. Urol Int 91(1):1–9 Mereu L, Gagliardi ML, Clarizia R, Mainardi P, Landi S, Minelli L (2010) Laparoscopic management of ureteral endometriosis in case of moderate-severe hydroureteronephrosis. Fertil Steril [Internet] 93(1):46–51. https://doi.org/10.1016/j.fertnstert.2008.09.076 Ceccaroni M, Ceccarello M, Caleffi G, Clarizia R, Scarperi S, Pastorello M et al (2019) Total laparoscopic ureteroneocystostomy for ureteral endometriosis: a single-center experience of 160 consecutive patients. J Minim Invasive Gynecol [Internet] 26(1):78–86. https://doi.org/10.1016/j.jmig.2018.03.031 Seracchioli R, Raimondo D, Di Donato N, Leonardi D, Spagnolo E, Paradisi R et al (2015) Histological evaluation of ureteral involvement in women with deep infiltrating endometriosis: analysis of a large series. Hum Reprod 30(4):833–839 Sillou S, Poirée S, Millischer AE, Chapron C, Hélénon O (2015) Urinary endometriosis: MR Imaging appearance with surgical and histological correlations. Diagn Interv Imaging [Internet] 96(4):373–381. https://doi.org/10.1016/j.diii.2014.11.010 Nezhat CH, Malik S, Nezhat F, Nezhat C (2004) Laparoscopic ureteroneocystostomy and vesicopsoas hitch for infiltrative endometriosis. J Soc Laparoendosc Surg. 8(3–7):3 Yang C, Jones L, Rivera ME, Verlee GT, Deane LA (2011) Robotic-assisted ureteral reimplantation with Boari flap and psoas hitch: a single-institution experience. J Laparoendosc Adv Surg Tech 21(9):829–833 Alves J, Puga M, Fernandes R, Pinton A, Miranda I, Kovoor E et al (2017) Laparoscopic management of ureteral endometriosis and hydronephrosis associated with endometriosis. J Minim Invasive Gynecol 24(3):466–472 Bastu E, Celik HG, Kocyigit Y, Yozgatli D, Yasa C, Ozaltin S et al (2020) Improvement in quality of life and pain scores after laparoscopic management of deep endometriosis: a retrospective cohort study. Arch Gynecol Obstet [Internet] 302(1):165–172. https://doi.org/10.1007/s00404-020-05583-6 Angioni S, Nappi L, Sorrentino F, Peiretti M, Daniilidis A, Pontis A et al (2021) Laparoscopic treatment of deep endometriosis with a diode laser: our experience. Arch Gynecol Obstet [Internet] 304(5):1221–1231. https://doi.org/10.1007/s00404-021-06154-z Huang JZ, Guo HL, Li JB, Chen SQ (2017) Management of ureteral endometriosis with hydronephrosis: Experience from a tertiary medical center. J Obstet Gynaecol Res 43(10):1555–1562 Isac W, Kaouk J, Altunrende F, Rizkala E, Autorino R, Hillyer SP, Laydner H, Long JA, Kassab A, Khalifeh A, Panumatrassamee K, Eyraud R, Falcone T, Haber GP, Stein RJ (2013) Robot-assisted ureteroneocystostomy: technique and comparative outcomes. J Endourol 27(3):318–323. https://doi.org/10.1089/end.2012.0196 Funding None. Author information Authors and Affiliations Contributions TY: protocol/project development, data collection, data analysis, manuscript writing, statistical analysis, and revision. TH: protocol/project development, data analysis, and manuscript writing. SY: protocol/project development and manuscript writing. KK: data collection. SS: data collection. MS: data collection. YY: data analysis and statistical analysis. MA: protocol/project development and responsible surgeon. Corresponding author Ethics declarations Conflict of interest All authors have no conflict of interest to report. Ethical approval This retrospective study was performed in accordance with the Declaration of Helsinki was and approved by the Institutional Review Board of our hospital (IRB number: 877). Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary Information Below is the link to the electronic supplementary material. Rights and permissions About this article Cite this article Yamada, T., Hada, T., Yanai, S. et al. Rate of recurrent hydronephrosis after laparoscopic ureteroneocystostomy for ureteral endometriosis. Arch Gynecol Obstet 306, 133–140 (2022). https://doi.org/10.1007/s00404-022-06462-y Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00404-022-06462-y